<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609061
Report Date: 02/05/2021
Date Signed: 02/05/2021 04:46:41 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/04/2021 and conducted by Evaluator Yelena Avetisyan
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210204170823
FACILITY NAME:WEST VALLEY ASSISTED LIVINGFACILITY NUMBER:
197609061
ADMINISTRATOR:MILLAN, JONATHANFACILITY TYPE:
740
ADDRESS:7055 SHOUP AVENUETELEPHONE:
(818) 883-7201
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:90CENSUS: 38DATE:
02/05/2021
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Jonathan MillanTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee failed to follow fire safety requirement by installing non-removable screw through windows
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Yelena Avetisyan initiated an initial complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was initiated Telephonically at 4:00 pm with Administrator Jonathan Millan.

It was reported that licensee installed non-removable screw through resident rooms windows that prevents them from opening the window more than 6 inches. On 2/3/2021 approximately 4:10 pm LPA conducted with representative from LAFD who informed LPA that the windows in resident rooms are considered emergency exit and the licensee cannot install anything that prevents them from opening. Additionally on approximately 4:45 pm on 2/4/2020 LPA conducted interview with administrator Jonathan Millan who confirmed that non-removable screws were placed on the second floor windows. A discussion was held with Mr. Millan regarding this action. Mr. Millan agreed to remove all the screws from the windows.

Based on the information obtained the allegation is Substantiated at this time.
A telephonic exit interview was conducted/ Copy was provided via email for signature.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Yelena AvetisyanTELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20210204170823
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WEST VALLEY ASSISTED LIVING
FACILITY NUMBER: 197609061
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/05/2021
Section Cited
CCR
87203
1
2
3
4
5
6
7
Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.
This requirement was not made as evidenced by:
1
2
3
4
5
6
7
.Administrator sent an email to LPA on 2/4/2021 confirming that the screws have been removed from all the windows.
8
9
10
11
12
13
14
Based on interviews conducted which confirmed that licensee did not comply with the section cited above by installing non-removable screws on resident room windows which poses and immediated health and safety and personal rights risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Yelena AvetisyanTELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2